Depression in the United States and Japan: Gender, marital status, and SES patterns

ARTICLE IN PRESS

Social Science & Medicine 61 (2005) 2280–2292 www.elsevier.com/locate/socscimed

Depression in the United States and Japan: Gender, marital status, and SES patterns Akihide Inabaa, Peggy A. Thoitsb,, Koji Uenoc, Walter R. Goved, Ranae J. Evensond, Melissa Sloand b

a Tokyo Metropolitan University, Tokyo, Japan University of North Carolina Chapel Hill, NC, USA c Florida State University, USA d Vanderbilt University, USA

Available online 22 August 2005

Abstract A number of investigators have claimed that higher depression scores and higher rates of depressive disorder are found worldwide in women, unmarried persons, and people of low socioeconomic status (SES). A closer look, however, indicates that patterns for Asian countries are less consistent than claimed. As a case in point, using comparable data from the National Family Research of Japan ‘98 survey (N ¼ 6985) and the National Survey of Families and Households in the US (N ¼ 8111), we examine the distributions of depressive symptoms by gender, marital status, and SES, with a short form of the CES-D Scale. Bivariate and multivariate analyses show that depressive symptoms are higher in women, unmarried persons, and those with lower family incomes in both countries, but there is no association between education and depression in Japan while symptoms are inversely related to education in the US. We argue that the lack of relationship between education and depression in Japan is not an artifact of measurement but a product of Japan’s distinctive stratification processes relating to occupation. Cross-national variations around ‘‘general’’ patterns are important because they offer clues to more specific cultural and structural factors involved in the social etiology of mental disorder. r 2005 Elsevier Ltd. All rights reserved. Keywords: Depression; Cross-cultural differences; CES-D; Japan; USA

Introduction According to reviewers, most cross-cultural studies show that women, unmarried persons, and those of lower education, income, or occupational prestige have higher rates of depressive disorder and/or depressive symptoms than men, the married, and those in more advantaged socioeconomic status (SES) positions (e.g., Corresponding author. Tel.: +1 919 962 5605; fax: +1 919 962 7568. E-mail address: [email protected] (P.A. Thoits).

Kohn, Dohrenwend, & Mirotznik, 1998; Nolen-Hoeksema, 1990; Weissman et al., 1996). Although no one has claimed that these patterns are universal, reviewers usually imply that they are true in most countries. For example, Rosenfield (1989, p. 77) claims that higher depression rates in women exist ‘‘across cultures, over time, in different age groups, in rural as well as urban areas, and in treated as well as untreated populations.’’ Kohn and his colleagues (1998, p. 275) state that distributions of psychiatric disorders by gender and SES are well-established inside and outside the US, and, by implication, applicable worldwide. (See also Kessler,

0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.07.014

ARTICLE IN PRESS A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

2002, p. 61.) A closer look at the epidemiological literature indicates that such conclusions are premature, particularly with respect to Asian nations. This inference is underscored again in this paper when we compare gender, marital status, and socioeconomic differences in depressive symptoms in the US to those in Japan— which has rarely been included in cross-national comparisons. A brief overview of patterns in the United States In recent years, information on gender, marital status, and SES differences in depression in the US has been obtained from two types of studies (Kohn et al., 1998), those employing community screening scales such as the Center for Epidemiological Studies-Depression Scale (CES-D) (Radloff, 1977) and those using standardized interviews to assess psychiatric disorders that are described in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980, 1987, 1994). In these latter types of research, symptoms defining the most common or serious disorders in the diagnostic manuals are converted into structured sets of questions that can be asked by trained lay interviewers in face-to-face surveys with probability samples of adults. Computer algorithms convert respondents’ answers into diagnoses which are more reliable than those based on psychiatrists’ judgments. The most widely cited epidemiological studies that use standardized diagnostic interviews in the United States are the Epidemiological Catchment Area studies (ECA), which were carried out in five metropolitan areas in the US (Weissman, Bruce, Leaf, Florio, & Holzer, 1991); the National Comorbidity Survey (NCS), based on a national probability sample (Kessler & Zhao, 1999); and the National Comorbidity Survey Replication (NCS-R), again based on a nationally representative sample (Kessler et al., 2003). All three obtained similar findings for the distributions of depression by gender and marital status. Women had higher lifetime and/or 12-month prevalence rates of major depressive disorder than men (ECA, NCS, NCS-R) and higher lifetime and 1-year rates of dysthymia (a depressed mood that has endured for at least 2 years) compared to men (NCS). Formerly married persons had significantly greater lifetime and/or 1-year rates of depression than the married in the ECA (Weissman et al., 1991), the NCS (Kessler & Zhao, 1999) and the NCS-R (Kessler et al., 2003). Distributions of major depression by SES in the three investigations were less consistent, however—inversely related only for some of the indicators commonly used for SES (e.g., education, income, employment status). In the ECA, individuals’ education, occupation, and income were unrelated to rates of major depression, but unemployed persons and those on welfare were

2281

more likely to have had a major depression during the past 12 months compared to their more advantaged counterparts (Robins et al., 1984; Weissman et al., 1991). In the NCS, both income and education varied inversely with the 12-month prevalence of major depression (Kessler et al., 1994). In the NCS-R, major depressive disorder was negatively related to education but not income; however, individuals who were not employed and those living in or near poverty had higher rates of major depressive disorders (Kessler et al., 2003). Thus, distributions of depression by measures of SES in the ECA, NCS, and NCS-R projects are less consistent than those by gender and marital status, although one still can discern an overall trend toward an inverse association. Community mental health studies conducted in the US that employ depression screening scales, especially the widely used CES-D Scale, mirror the distributions found in the diagnostic interview surveys. Community studies consistently report higher symptoms of depression in women than men (Gove & Tudor, 1973; Kohn et al., 1998; Link & Dohrenwend, 1980; Mirowsky & Ross, 2003; Turner & Lloyd, 1999). Never-married and formerly-married individuals exhibit greater depression scores compared to the married (Mirowsky & Ross, 2003; Turner & Lloyd, 1999). And, in contrast to the findings of diagnostic interview studies, significant inverse relationships between scores on depression scales and education, income, and occupational status are repeatedly found (Kessler, 1982; Kohn et al., 1998; Link & Dohrenwend, 1980; Mirowsky & Ross, 2003; Turner & Lloyd, 1999). This is in part because depression scores are continuous measures (in contrast to dichotomous variables for diagnoses) and therefore are more likely to discern group differences (Mirowsky & Ross, 2003). Unequal distributions of affective disorders and depressive symptoms by gender, marital status, and SES have also been established in many other nations (for comprehensive reviews see Dohrenwend et al., 1980; Kohn et al., 1998; Nolen-Hoeksema, 1990; WHO International Consortium in Psychiatric Epidemiology, 2000), leading researchers to assume that these patterns generalize across cultures and over time. However, a careful look at the range of countries in which studies have been conducted indicates that such conclusions are far too sweeping. Most have occurred in industrialized Western nations, including Canada, Great Britain, Australia, Germany, France, Spain, the Netherlands, Israel, Poland, Hungary, Sweden, and Norway, among many others, mostly European. Studies of Asian populations are exceedingly rare. Our search of English-language psychological, sociological, psychiatric, and public health journals uncovered only a handful of investigations in Asian countries from 1980 to the present that were based on representative samples. The majority of these were performed in Taiwan and South

ARTICLE IN PRESS 2282

A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

Korea as part of a 10-nation comparative epidemiological project by the Cross-National Collaborative Group, which utilized a standardized diagnostic interview based on DSM-III criteria, to facilitate comparisons across societies (Weissman et al., 1996). The ten countries were the United States, Canada, Puerto Rico, France, West Germany, Italy, New Zealand, Lebanon, Taiwan, and South Korea. A new multi-nation epidemiological effort that employs an interview based on DSM-III-R diagnostic criteria is in progress by the International Consortium of Psychiatric Epidemiology (ICPE) (Andrade et al., 2003). This study includes the US, Canada, the Czech Republic, Germany, the Netherlands, Turkey, Brazil, Chile, Mexico, and Japan. Studies that use depressive symptom scales with random samples of Asian adults are even rarer in Englishlanguage journals, although work by Lin and his colleagues in China is a notable exception (e.g., Lin & Lai, 1995). Depression in Asian nations When we examine the results of those few epidemiological and community mental health studies that have been conducted in Asian nations, we find fairly consistent distributions of depression by gender but surprisingly sparse consideration of marital status or SES differences. Gender differences The Cross-National Collaborative Group found higher lifetime and/or 12-month rates of major depressive disorder for women compared to men across all ten nations, including Taiwan and South Korea (Lepine, 2001), urban women in Seoul (Lee et al., 1990a), rural women in South Korea (Lee et al., 1990b), and women in Taiwan (Hwu, Chang, Yeh, Chang, & Yeh, 1966). Occurrences of major depressive and dysthymic disorders were also greater for women than men on Kangwha Island, South Korea (Lee, 1991) and in Hong Kong (Chen et al., 1993). Also, Lin and Lai (1995) reported that females had significantly higher mean CES-D depression scores than males in the city of Tianjin in the People’s Republic of China. In Japan, in contrast to other epidemiological studies, no significant gender differences in the prevalence of major depression or dysthymia were found (Kawakami, Shimizu, Haratani, Iwata, & Kitamura, 2004), although it is notable that the odds ratio for the 12-month prevalence of major depressive episodes in Japan was 2.5 women to 1.0 men, higher than in any other nation in the ICPE study (Andrade et al., 2003). Unlike earlier Cross-National Collaborative studies in which households were randomly sampled, Japanese participants in the ICPE survey were drawn from one prefecture’s voter list, with a response rate of 57%, and diagnostic

questions were self-administered rather than by interview. These design limitations may have affected results. In general, then, as in Western nations, affective disorders and depressive symptoms seem more frequent in women than men in Asian countries, although studies are limited in number, findings are not perfectly consistent across nations, and research has been conducted in only a handful of Asian cultures and locations. Marital status differences In contrast to gender differences, few studies examine marital status differences in depression in non-Western nations, and findings differ. Across all ten nations in the Cross-National Collaborative Group project, including Taiwan and South Korea, separated and divorced individuals showed higher lifetime and/or 12-month prevalence of major depression compared to married persons (Weissman et al., 1996), and formerly married persons in Taiwan were more likely than married individuals to have had major depression (Hwu et al., 1966). However, on Kangwha Island, South Korea, married persons’ rates of major depression and dysthymia were elevated compared to the unmarried, a reversal in pattern (Lee, 1991). Finally, across the ten samples in the ICPE survey, unmarried persons were more likely to have had a major depressive episode only in four of the ten countries surveyed (all Western nations—Canada, Chile, the Netherlands, and US); there were no marital status differences in depressive episodes in Japan, the only Asian country examined in the ICPE (Andrade et al., 2003). SES differences With respect to distributions of depression by SES in Asian countries, there is even more inconsistency. The lifetime and/or 12-month prevalence of major depressive disorder was elevated among individuals with low versus high levels of education in Taiwan (Hwu et al., 1966) and an inverse relationship between education and dysthymia was reported for Kangwha Island (Lee, 1991). However, income and education were unrelated to depressive episodes in the ICPE Japanese sample (Andrade et al., 2003). And in Tianjin, China, years of education, occupational prestige, and monthly earnings were unrelated to depressive symptom scores (Lin & Lai, 1995). Summary Studies of the distributions of affective disorder and/ or depressive symptoms by gender, marital status, and SES have occurred primarily in three Asian nations (Taiwan, South Korea, and mainland China, with Japan constituting a very recent addition), have been few in number, have reported generally consistent distributions by gender, and have produced somewhat inconsistent

ARTICLE IN PRESS A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

patterns by marital status and SES. Given the relative paucity of available studies of Asian populations, the claim that women, the unmarried, and those of lower SES have higher rates of affective disorders and/or depressive symptoms both inside and outside the US is at best overstated. Although these patterns indeed appear to apply to some Western industrialized nations (particularly the US), considerably more evidence would be needed before one could confidently extrapolate them to most non-Western societies. Consequently, as one of many still necessary steps in this direction, in this paper we compare distributions of depressive symptoms in nationally representative samples of Japanese and American adults. We take advantage of a first-ever, large-scale national survey conducted in Japan in 1998–1999, the National Family Research of Japan ‘98 (NFRJ98). This is the first nationally representative survey of an Asian nation that includes mental health measures and is open to researchers as public use data. The NFRJ98 includes multiple items from the CES-D. For comparison purposes, we employ the second wave of the National Survey of Families and Households (NSFH), conducted in 1994 in the US. This is ideal for comparison purposes as it too has a nationally representative sample, respondents were interviewed within the same time frame as the Japanese sample, and the survey includes CES-D items comparable to those used in the Japanese study. Neither study assessed affective disorders using DSM criteria, but as seen in US studies, gender, marital status, and SES distributions of symptoms mirror epidemiological patterns of major depression. As Mirowsky and Ross (2003) have observed, depression scales have the advantage of capturing greater variations in mental health than do dichotomous indicators of disorder, increasing the likelihood of discerning sociodemographic differences. Japan as a useful comparison nation Epidemiological and community surveys establish patterns in the distributions of depression, and these patterns in turn serve as clues to the social etiology of depression. We believe it is useful to compare Japanese and American distributions of depression because Japan differs in a number of ways from the US in family, interpersonal, and business cultures (e.g., Benedict, 1946; Brinton, 1993; Hamabata, 1990; Markus & Kitayama, 1991; Nakane, 1973) as well as in family, social network, and workplace structures (Boling, 2000; Bramlett & Mosher, 2001; Tseng et al., 2001). At the same time, Japan is the only non-Western advanced industrialized democratic nation, and, much like the US, it is highly urbanized and economically and educationally advantaged (CIA, 2002; National Center for Education Statistics, 1999; Tseng et al., 2001). We

2283

expect to find similarities in the distributions of depressive symptoms in the two countries in part because they share these latter characteristics and in part because women, the unmarried, and people with lower education and income in both nations are more often exposed to social devaluation, discrimination, and major life stressors than their sociodemographic counterparts (e.g., Boling, 2000; Krause, Jay, & Liang, 1991; Turner & Lloyd, 1999; Wright, Baxter, & Birkelund, 1995), and these are conditions that raise the risk of depression. If we find that depressive symptoms are distributed differently in the two countries, however, this will point to more specific cultural and/or structural factors that differ between them rather than to broader discrepancies in industrialization, urbanization, GDP, educational levels, or quality of life, some or all of which distinguish South Korea, Taiwan, and the People’s Republic of China, for example, from the US and Japan.

Methods Japanese NFRJ98 sample The National Family Research of Japan ‘98 survey (NFRJ98) was conducted by the Japan Association of Family Sociology (Inaba, 2004; Watanabe, Inaba, & Shimazaki, 2004). Two-stage stratified random sampling was conducted in 1998 to select a nationally representative sample of adults born during a 50-year period (1921–1970). Respondents were aged 28–77 and living in Japan in October 1998 (N ¼ 10; 500). The age range was designed to allow a comparative analysis of birth cohorts. Stratification was based on a combination of four factors: prefecture, town size, sex of respondent, and birth cohort. Data collection occurred the next year, in January and February of 1999, by self-administered questionnaire (so respondents’ ages ranged from 28 to 78). Questionnaires were delivered to respondents and picked up after completion. The response rate was 66.5 percent, with an N of 6985. Unmarried men with low education living in urban areas and young unemployed persons were less likely to participate in the survey (Inaba, 2004); the sample differed little from the population as a whole in sex or age, but more educated, married, and employed respondents were slightly over-represented relative to their counterparts in the population (Watanabe et al., 2004). Sampling weights are not used in this analysis as the demographics of the sample were very similar to those of the census. American NSFH sample Data for the United States portion of this paper come from the second wave of the National Survey of

ARTICLE IN PRESS 2284

A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

Families and Households (NSFH-2) collected in 1994. The NSFH is a two-wave panel study based on a national multistage area probability sample of households in the US. The first wave of the NSFH was collected in 1987 and 1988 from 9643 individuals ages 19 and older. An additional 3374 persons were selected to over-represent certain minority groups (e.g., blacks, Hispanics, cohabitors, the recently married as well as single- and step-parents). Data were collected in structured face-to-face interviews. The first wave of the survey had a response rate of 74%. Excluding respondents who had died (N ¼ 763), the Time 2 sample contains 10,005 of the original Time 1 respondents for a Time 2 response rate of 81% (see Sweet & Bumpass (1996) for a detailed description of the design and content of the NSFH). To correct for unequal sampling probabilities for various subgroups in the NSFH survey, weighted data are used in all analyses that are reported here (using the Time 2 weights). In order to make the NSFH sample comparable to the NFRJ98 sample in age, we selected only respondents who were 28–78 years old at the Time 2 interview, resulting in a weighted N of 8111.

We excluded these respondents (N ¼ 230) from all analyses of depression scores. For this reason and because the Japanese survey was self-administered, numbers of missing cases increase from the univariate to the bivariate to the multivariate analyses. (When all analyses were based only on the listwise-missing N, all patterns presented in this paper were replicated.) In the NSFH-2, interviewers administered the items, which were worded as follows: ‘‘Next is a list of the ways you might have felt or behaved during the past week. On how many days during the past week did you: Feel bothered by things that usually don’t bother you; Feel that you could not shake off the blues even with help from your family or friends; Feel depressed; Have trouble keeping your mind on what you were doing; Not feel like eating, Your appetite was poor; Feel that everything you did was an effort; Feel fearful; Sleep restlessly; Talk less than usual; Feel lonely; Feel sad?’’ Item responses could range from 0 (none) to 7 days. To correspond to the response categories in the Japanese NFRJ98, days were collapsed as follows: 1 ¼ 0 days, 2 ¼ 1 or 2 days, 3 ¼ 3 or 4 days, and 4 ¼ five or more days. Scores thus ranged from 11 to 44. Cronbach’s alpha was .92 for the US sample.

CES-D Depression Cross-cultural measurement issues Sixteen items from the 20-item CES-D Scale were included in the Japan-NFRJ98 survey, and 12 items were included in the American-NSFH in 1994. Eleven were common to both surveys and were comparably worded; we use only those items in the analysis. In Japan, the self-administered questions were as follows: ‘‘We would like to ask you about your physical or mental state during the past week. How often did you experience each of the following feelings or matters? Circle your answer to each question: I was bothered by things which usually don’t bother me; I felt that I could not shake off the blues, even if my family or friends cheered me up; I felt depressed; I had trouble keeping my mind on what I was doing; My appetite decreased; I felt that everything I did was an effort; I felt fearful; I had trouble sleeping; I talked less than usual; I felt lonely without company; I felt sad.’’ Responses were 1 ¼ not at all, 2 ¼ one or two days a week, 3 ¼ three or four days a week, and 4 ¼ almost every day. (The translation of NFRJ98 items here follows the English version of the questionnaire published by the Japan Society of Family Sociology (http://www.waseda.jp/ assoc-nfroffice/NFRJ98_questionnaire_eng.htm.) Possible scores ranged from 11 to 44 in value. The internal consistency of the scale was .88 (Cronbach’s alpha). Prior studies of responses to the 16-item version of the CES-D Scale that was included in the NFRJ98 showed that some respondents rated all 16 items (including four reversed items) as ‘‘1,’’ indicating a response set (Inaba, 2002). (No one consistently rated all 16 items as ‘‘4.’’)

Our strategy of analysis in this paper is based on the fact that there are serious difficulties in comparing the symptom scores of two ethnic or national groups to one another (Elder, 1976). If scores differ significantly, it may indicate a true difference in the frequency or intensity of depressive experiences in the two countries. Alternatively, one group may give more extreme responses than the other to the same items, differences in the underlying meaning or social desirability of each item may produce differing scores (e.g., Lee, 1991; Price, Shea, Murry, & Hilditch, 1995), or two groups may differ in their retrospective memory and weighting of pleasant and unpleasant emotional experiences when summarizing and reporting global well-being over a specified time period (Oishi, 2002). On the other hand, if symptom scores are the same across the two groups, we might be tempted to assume that there is no true national difference in the prevalence of depressive experiences. But culturally varying ways of responding to questions may produce the same average scores. For example, one group might report many symptoms of low intensity while the other group reports few symptoms of high intensity, or the two groups may interpret symptoms very differently yet still produce the same average scores. These are almost intractable problems—there is no gold standard against which to assess the meaning of scores across two cultures. Fortunately, there is evidence that respondents in both the US and Japan respond to depressive symptom items

ARTICLE IN PRESS A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

2285

in similar ways. For example, one study suggests that the factor structure of the CES-D is alike for Japanese respondents to the NFRJ98 and American respondents to the NSFH (Kikuzawa, 2001), another indicates that Japanese and American workers answer negatively worded items on the CES-D similarly (Iwata, Roberts, & Kawakami, 1995), and a third indicates that somatic complaints, retarded activities, and depressed mood factor together in Japanese and American samples (Iwata & Roberts, 1996). In this paper, however, we sidestep potential measurement problems by avoiding direct comparisons of mean depression scores across the two samples. We instead compare patterns in the direction and significance of associations between sociodemographic variables and depression scores within each sample. If, for example, women score significantly higher than men in both Japan and the US on CES-D items that are as similar as possible in their wording and response categories across the two surveys, then we conclude that women are more depressed than men in both nations, at least as measured by this scale (see Krause et al., 1991 for a similar analytic strategy).

5 ¼ 4–5.99 million yen, 6 ¼ 6–7.99 million yen, 7 ¼ 8–9.99 million yen, 8 ¼ 10–11.99 million yen, 9 ¼ 12 million yen or more. Total family income included occasional/temporary income, supplemental income, pension, and public assistance earned or received by all members of the household. In the NSFH, household income was measured in dollars per year. Because about a quarter of the sample were missing on this variable at Time 2, we substituted predicted income for the missing values. Respondents were subdivided by gender, and income was estimated based on the respondent’s employment status, marital status, race, and completed education. After substitution, there remained only 34 missing cases on household income. Because levels of educational attainment and the meaning of various educational milestones are not strictly comparable between the two nations, and because measures of family income and monetary units are so different in the two surveys, we treat education and family income as ordinal rather than categorical variables in the bivariate and multivariate analyses.

Sociodemographic variables

Statistical analyses

Female is coded 1 and male as 0. Marital status consists of married, separated/divorced, widowed, and never-married categories. For some analyses, we collapse marital status so that married ¼ 1 and unmarried ¼ 0. Age is measured in years. As indicators of SES, we examine education and family income because they are applicable to all respondents in the two samples, in contrast to occupational prestige, which applies only to the employed. Education in the Japanese NFRJ98 is assessed with ordinal categories indicating the type of school that the respondent last attended: 1 ¼ junior high school; 2 ¼ high school or vocational school for high school graduates; 3 ¼ junior college or technical college; and 4 ¼ 4-year university or post-graduate education. Years of schooling in Japan are very similar to those in the US, corresponding roughly to 9 years for junior high (completion of junior high is compulsory in Japan), 12 years for high school, 14 years for junior college or technical school, and 16 years or more for a 4-year university degree or post-graduate education. In the American NSFH, education was measured in years of schooling completed, but was collapsed into five ordinal categories to enhance similarities between the two studies: 1 ¼ 8th grade or less, 2 ¼ 9th through 11th grade, 3 ¼ completed high school, 4 ¼ some college, 5 ¼ college degree or higher (including masters, doctorate, or professional degrees). Family income is coded in the NFRJ98 as follows: 1 ¼ did not have any income, 2 ¼ less than 1 million yen, 3 ¼ 1–1.99 million yen, 4 ¼ 2–3.99 million yen,

All analyses are conducted separately by nation. We present descriptive data on the two samples first, followed by the distributions of mean CES-D scores and CES-D z-scores by gender and marital status, and the correlations of these scores with respondents’ age, education, and family income. We then use OLS regression to assess the effects of each sociodemographic variable on depressive symptoms net of the others. Finally, to further understand a puzzling lack of relationship between educational level and depression in the Japanese sample, we explore possible interactions by repeating these multiple regressions separately by gender and by age cohort, within each sample. In all regression results, we present standardized (rather than unstandardized) coefficients to ease comparisons across samples.

Results Table 1 displays the basic sociodemographic characteristics of the two samples. The gender distributions are quite similar. Note that a much higher percentage of Japanese respondents are married (81%) than Americans (69%). This is due almost entirely to the higher number of divorced and separated individuals in the American sample (14%), compared to the Japanese (3%), reflecting the higher divorce rate in the US. When the unmarried categories are collapsed, the percentages of men and women in the two samples who are married vs. unmarried are quite similar across the two samples.

ARTICLE IN PRESS A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

2286

Table 1 Sociodemographic characteristics of the Japanese and US samples Japan

US

Men Women

48% 52%

47% 53%

Married Divorced/separated Widowed Never married

81% 3% 6% 9%

69% 14% 7% 10%

Men Married Unmarried

40% 8%

35% 12%

Women Married Unmarried

41% 11%

34% 19%

Age

51.5 (13.7)c

47.6 (13.7)

Educational level

2.2 (1.0)

2.5 (1.0)

Family incomeb

5.8 (1.8)

$47,305 ($40,534)

N

6985

8111

a

a

In Japan, four educational levels were distinguished and in the US, five levels were coded. For purposes of comparison here, US categories were recoded so that grade school and junior high school in the US were collapsed into ‘‘less than high school.’’ b In Japan, family income is measured ordinally, coded from 1 to 9; category 5 ¼ 4–5.99 million yen. In the US, dollars per year are assessed. c Standard deviations are in parentheses.

The average age of both groups of respondents is about 50. Mean scores on education indicate that the average Japanese respondent has attended high school and the average American has a high school diploma or some years of college. Mean family income in Japan fell in the range of 4–5.99 million yen (roughly equivalent to $50,000 in 1999 US dollars); average income in the US sample was roughly $47,300. In general, then, there are considerable similarities between the two groups, with the exception of a far higher percentage of divorced and separated respondents in the American sample. Table 2 reports the mean depression scores (and, for comparison purposes, the mean depression z-scores) for the total sample and by gender and marital status. Also shown are correlations of age, education, and family income with depression scores in each country. It is clear that American respondents’ depression scores are systematically higher than those of Japanese respondents for the total sample and regardless of gender or marital status. This overall pattern is consistent with reports of lower overall rates of affective

disorders in other Asian nations (China, South Korea, and Taiwan) compared to the US (Kawakami et al., 2004; Kleinman, 1986; Lepine, 2001) and with comparisons of depressive symptom scores across elderly Japanese, Taiwanese, and American respondents (Krause & Liang, 1992). More central to our goals, however, are the distributions of depression within each country. As expected, Table 2 shows that Japanese and American women are more depressed than their male counterparts, unmarried respondents are more depressed than married respondents in each country, and this pattern also holds when unmarried individuals are compared to married persons within gender, in both nations. Table 2 also shows that older adults are significantly less depressed than younger adults in both Japan and the US. Depression scores are inversely correlated with educational level in the US, but, unexpectedly, are not associated with education in Japan. Family income and depression are inversely and significantly associated in both countries. Table 3 re-examines these relationships in a multivariate format. In Model 1, we regressed depression scores on gender, age, marital status, education, and family income. We see in both samples that women have significantly higher depression scores than men, older adults’ scores are lower than their younger counterparts’, married individuals are less depressed than the unmarried, and those with substantial family incomes score lower on depressive symptoms compared to less affluent persons. Only the effects of education differ between the two countries. As seen previously in Table 2, educational attainment is unrelated to depression in Japan but is significantly and inversely related to symptoms in the US. Model 2 in Table 3 substitutes gender by marital status dummy variables for ‘‘female’’ and ‘‘married’’ to assess interactions between these two statuses. Unmarried men, married women, and unmarried women are significantly more depressed than married men (the omitted comparison group) in both samples, consistent with well-established patterns in the distributions of distress and depression in the US (Gove, 1972; Mirowsky & Ross, 2003). The effects of other variables remain the same as in Model 1, including the absence of a link between schooling and depression in the Japanese survey. (These findings remain the same when a control variable for minority status [0 ¼ white, 1 ¼ minority group member] is added to the US equations.) The utter lack of relationship between educational level and depressive symptoms in Japan shown in Tables 2 and 3 was puzzling. We explored a number of explanations. It was possible that the relationship was curvilinear, but an inspection of mean depression scores at each level of education in Japan and the US indicated only a linear relationship (not shown). We examined

ARTICLE IN PRESS A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

2287

Table 2 Means and standard deviations of CES-D scores for the Japanese and US samples Japan

US N

Mean

St.D.

.00

6299

18.2

7.2

.00

8111

5.0 5.4

.08 .07

2977 3322

17.2 19.1

6.5 7.6

.14 .13

3792 4329

15.9 17.7 17.2 17.5

4.9 6.1 6.3 6.0

.05 .29 .19 .25

5128 211 356 581

17.4 20.8 19.6 19.1

6.6 8.4 8.0 7.6

.12 .36 .20 .13

5558 1170 575 809

Men Married Unmarried

15.4 18.0

4.6 6.2

.16 .35

2502 475

16.5 18.9

6.1 7.3

.23 .10

2804 988

Women Married Unmarried

16.4 17.1

5.2 6.1

.04 .17

2626 696

18.2 20.7

6.9 8.5

.00 .35

2754 1565

Mean

St.D.

Total

16.2

5.2

Men Women

15.8 16.6

Married Separated/divorced Widowed Never married

Age Education Family income

Mean Z

Correlation with CES-D

Correlation with CES-D

.08*** .00 .09***

.06*** .13*** .15***

Mean Z

N

*** po:001. Table 3 Regressions of depressive symptoms on sociodemographic characteristics in Japan and the US Japan

US

Model 1 Female (0,1) Age Married (0,1) Education Family income R2 N

.06*** .09*** .10*** .00 .08*** .03 5623

.11*** .10*** .13*** .12*** .07*** .07 8098

Model 2 Age Unmarried man (0,1) Married woman (0,1) Unmarried woman (0,1) Education Family income R2 N

.08*** .11*** .09*** .09*** .00 .08*** .04 5622

.10*** .08*** .10*** .20*** .12*** .07*** .07 8098

*** po:001. Standardized coefficients are reported. Married men are the omitted comparison group in Model 2.

whether the relationship was contingent on gender or age cohort, as young Japanese men enroll in 4-year universities at three times the rate of young women

(Brinton, 1993, p. 200), and older cohorts have fewer years of schooling than younger ones. However, when the Table 3 equations were re-estimated separately for men versus women, and for ages 28–39, 40–49, 50–59, and 60–78 (see Table 4), schooling was unrelated to depression for both men and women in Japan, but significantly and inversely linked to depressive symptoms in the US for both genders. Education also had no association with symptoms in Japan for all age groups, but was significantly and negatively related to depression in the US for all cohorts. We then substituted subjective health status for depression scores in our Tables 2 and 3 analyses as an alternative indicator of well-being (not shown). In Japan, respondents were asked, ‘‘How would you describe the general state of your health during the past year?’’ (5 ¼ very bad to 1 ¼ very good). In the US, the question was, ‘‘Compared with other people your age, how would you describe your health? (5 ¼ very poor to 1 ¼ excellent). In both countries, education was negatively and significantly related to subjective poor health (in Japan, r ¼ :13, po:001, in the US, r ¼ :21, po:001), and these effects were sustained in multivariate analyses, suggesting that education’s lack of effect among Japanese respondents was specific to depression and did not extend to physical health. Because poor health was correlated with depression scores very similarly in the two countries (r ¼ :35, po:001, in Japan, and r ¼ :32, po:001, in the US), the absence of an effect

ARTICLE IN PRESS A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

2288

Table 4 Regressions of depressive symptoms on sociodemographic characteristics, by gender and by Age cohort Men

Age Married (0,1) Education Family income R2 N

Women

Japan

US

Japan

US

.10*** .16*** .01 .08*** .05 2741

.09*** .13*** .10*** .07*** .05 3787

.07*** .04* .01 .08*** .01 2882

.12*** .13** .13*** .08*** .06 4312

Ages 28–39

Unmarried men (0,1) Married women (0,1) Unmarried women (0,1) Education Family income R2 N

Ages 40–49

Ages 50–59

AGES 60–78

Japan

US

Japan

US

Japan

US

Japan

US

.13*** .07* .09** .01 .03 .02 1357

.11*** .10*** .25*** .09*** .07*** .07 2831

.13*** .13*** .07* .06 .12*** .04 1284

.10*** .09*** .15*** .17*** .08*** .07 2049

.11*** .09** .06 .02 .13*** .04 1336

.06* .13*** .26*** .09*** .11*** .10 1356

.09*** .07* .11*** .04 .07* .03 1646

.05* .10*** .16*** .12*** .04 .04 1862

* po:05; ** po:01; *** po:001. Standardized coefficients are reported. Married men are the omitted comparison group in the second panel.

of educational attainment on depression in Japan cannot easily be explained as a measurement artifact.

Discussion Other evidence offers hints that years of schooling and depression are not associated in Japan. Kohn, Naoi, Schoenbach, Schooler, and Slomczynski, 1990 compared the psychological functioning of employed American, Japanese, and Polish men across a variety of positions in the class structure. Included among their measures of functioning was an indicator of psychological distress, a composite of anxiety, self-deprecation, low self-confidence, distrust, and nonconformity in ideas. They showed that psychological distress was associated as expected with social class position in both countries when class was operationalized as control over the means of production or the labor power of others. In Japan, the multiple correlation coefficient was .22 (po:05) and in the US it was .18 (po:05) (Kohn et al., 1990: Table 3). However, when Kohn and his colleagues correlated distress and SES (measured as a composite of education, job income, and occupational prestige), distress was entirely unrelated to SES in Japan (r ¼ :01, p ¼ NS) but negatively and significantly related to SES in the US (r ¼ :18, po:05). The lack of relationship between SES and distress in Japan is

particularly intriguing given that SES and social class measures were very highly correlated in both countries (r ¼ :75 in Japan, po:001; r ¼ :72 in the US, po:001). Similarly, using the Social Stratification and Social Mobility surveys conducted in Japan in 1975, 1985, and 1995, Kikkawa (2000) showed that years of education were very weakly related to life satisfaction in 1975 (beta ¼ .05) and completely unrelated to life satisfaction in both 1985 and 1995, while household income was significantly and positively associated with life satisfaction in all three surveys. We are inclined to believe that the absence of an influence of education on depressive symptoms may be attributable to differences between American and Japanese systems of stratification. As many observers have pointed out (e.g., Brinton, 1993; Cole & Tominaga, 1976; Kalleberg & Lincoln, 1988; Koike, 1983; Nakane, 1973), in Japan, educational achievement determines entry into high prestige firms or occupations, but the size and status of the company and movement up finely graded ladders of jobs within the company become the keys to individuals’ career success and earnings, not years of education. It is a common practice in business and other organizations to assign new employees to routine clerical jobs, even though they may be college graduates who were recruited specifically for professional, administrative, or managerial positions that they will hold eventually (Ishida, Goldthorpe, & Erikson,

ARTICLE IN PRESS A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

1991). Indeed, Kalleberg and Lincoln (1988) show that age, seniority in a company, and family needs (being married, having dependents) are the strongest determinants of promotions and earnings among Japanese workers (who obtain intensive in-house training in job skills), in contrast to American employees, whose incomes are influenced instead by job characteristics such as complexity and autonomy (which are linked to education), holding positions of authority, and union representation. Studies consistently show that overall status inequality and income inequality are lower among Japanese employees than Americans (e.g., Dore, 1973; Lincoln & Kalleberg, 1985), that the vast majority of Japanese adults (about 75%) consider themselves to be middle class (Kousaka, 2000; Kikkawa, 2000), and that this subjective class identification has remained unchanged since 1975 (Kikkawa, 2000). Japan is often characterized as a ‘‘status inconsistent’’ society—i.e., education, income, and occupational prestige are not as closely tied to individuals’ subjective class identifications as they are in other countries. In short, educational attainment may be far less consequential for depression than company size, seniority in the firm, and/or within-firm mobility, which are more strongly tied to families’ quality of life in Japan (Nakane, 1973).

Conclusions We have shown that distributions of depressive symptoms by gender, marital status, and family income in Japan and the US are very similar. Women, unmarried individuals, and people with lower incomes are significantly more depressed in both countries. These social patterns echo those found in epidemiological and community mental health studies in Western nations and some Asian nations, although it should be stressed again that marital status and SES distributions have been far less frequently examined and have yielded less consistent findings across Asian studies, in contrast to distributions by gender. Education represents an important exception in our findings. The absence of a relationship between education and depression in Japan and the presence of an inverse relationship in the US (especially in community studies using depression screening scales) underscores the point that cultural and/or structural factors that are particular to a nation will likely always introduce variations around general patterns. Claims that the same social distributions of depression exist worldwide (e.g., Kessler, 2002; Kohn et al., 1998) will probably always be too general and require qualification. The limitations of this study, however, must be acknowledged. One limitation is that it relies on a symptom scale rather than diagnostic criteria for

2289

depression. However, the literature shows that the CES-D Scale is an efficient and valid way to assess depressive symptoms in community populations, at least in the US (Eaton, Muntaner, Smith, Tien, & Ybarra, 2004), and distributions of symptoms by gender, marital status, and SES variables in community surveys generally replicate those found for affective disorders in surveys that use standardized diagnostic interviews in the US (Kessler & Zhao, 1999; Weissman et al., 1991). The covariation of depressive symptom scores and clinically defined affective disorders in Japanese samples is, of course, unknown because epidemiological studies conducted in Japan are so rare (but see Simon, Goldberg, Von Korff, & Ustun, 2002). Nevertheless, we believe a cross-national look at the distributions of depressive symptoms is a useful step, directing researcher attention to more specific cultural and structural factors that may be involved in the social etiology of depression in each country. Another limitation is that only a subset of CES-D symptoms was available in both data sets, possibly weakening the reliability of the depression scale used here. However, our scale contains no positively worded items from the CES-D, which have been shown to lower its internal consistency (Inaba, 2002; Kikuzawa, 2001); the factor structures of items common to the NFRJ98 and NSFH are equivalent (Kikuzawa, 2001); the 11 items constituting our scale primarily tapped somatic complaints, retarded activities, and depressive feelings, which factor together (Iwata & Roberts, 1996); and the 11 symptoms were strongly correlated and produced high internal consistencies (.88 in the Japanese sample, .92 in the American sample). All of these observations suggest that the subset of CES-D items that were available in the two surveys produced a reliable single measure of depressive feelings (Kikuzawa, 2001). The results in this paper for the US sample replicate findings of other North American studies that use the full 20item CES-D (e.g., Mirowsky & Ross, 2003; Turner & Lloyd, 1999). Finally, having only one measure of psychological problems in this study is also a limitation. Some researchers (Horwitz, 2002) advocate the use of multiple outcome measures in studies of general populations, observing that there are gender-characteristic ways of manifesting psychological difficulties (e.g., women through symptoms of anxiety and depression, men through excess drinking and drug use). Unfortunately, our two national surveys simply do not contain additional comparable mental health measures, for example, of alcohol or drug use. We have suggested that the absence of an educational attainment effect on depression in Japan may reflect differences in its stratification processes. Schooling tracks Japanese individuals into occupations and/or large companies (Brinton, 1993), but the Japanese nenko

ARTICLE IN PRESS 2290

A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

system (upward mobility with seniority) which still survives in large firms, coupled with intensive onthe-job training within companies, in-house welfare services, and corporate support for families may weaken the relationships among education, occupational status, and earnings, and dampen status and income inequality in the society overall (Kalleberg & Lincoln, 1988; Lincoln & Kalleberg, 1985). Japan is a nation of middle-class individuals who are additionally protected by a number of national social programs (health insurance, social security, pension plans, nursing insurance, etc.) that act as safety nets for most citizens, further lessening vulnerability to stressful life experiences. In short, we suggest that education’s influence on depression in Japan is dramatically attenuated by the country’s occupational and status structure and perhaps as well by its national welfare programs which may cushion less educated individuals from life exigencies. Alternatively, Japanese individuals who consider themselves middle class may have acquired through socialization important coping resources such as high self-esteem and a sense of personal control. These resources are positively and significantly associated with middle-class status in American and Canadian samples and known to be powerful stressbuffers (Turner, Lloyd, & Roszell, 1999; Turner & Roszell, 1994). If such coping resources are widely distributed in the Japanese population, they may dampen or suppress the relationship between education and depressive symptoms. These ideas remain speculative at present. A number of factors would need to be comparably assessed in both countries, for example, respondents’ occupational prestige, supervisory vs. non-supervisory positions, size and status of company, seniority in the firm, eligibility for benefits in various social welfare programs, subjective social class, sense of personal control, and so forth. In future work, pinpointing structural or cultural factors that operate differently in these two nations should help to clarify, more generally and theoretically, just how it is that social positions come to be linked differentially to mental health.

Acknowledgments The authors gratefully acknowledge the use of the National Family Research of Japan ‘98 (NFRJ98) survey conducted by the National Family Research Committee of the Japan Society of Family Sociology. The National Survey of Families and Households (NSFH) data were collected by the Center for Demography and Ecology at the University of Wisconsin, and the study was funded by the Center for Population Research of the National Institute of Child Health and Human Development, Grant No. HD21009.

References American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (third edition) (DSM-III). Washington, DC: American Psychiatric Press. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (third edition-revised) (DSM-III-R). Washington, DC: American Psychiatric Press. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (fourth edition) (DSM-IV). Washington, DC: American Psychiatric Press. Andrade, L., Caraveo-Anduaga, J. J., Berglund, P., Bijl, R. V., De Graaf, R., Vollebergh, W., et al. (2003). The epidemiology of major depressive episodes: Results from the international consortium of psychiatric epidemiology (ICPE) surveys. International Journal of Methods in Psychiatric Research, 12, 3–21. Benedict, R. (1946). The chrysanthemum and the sword: Patterns of Japanese culture. Rutland, VT: Charles E. Tuttle. Boling, P. (2000). Family policy in Japan. In J. M. Mercier, S. B. Garasky, & M. C. Shelley (Eds.), Redefining family policy: Implications for the 21st century (pp. 43–66). Ames, IA: Iowa State University Press. Bramlett, M. D., & Mosher, W. D. (2001). First marriage dissolution, divorce, and remarriage: United States. Advance data from vital and health statistics, No. 323. Hyattsville, MD: National Center for Health Statistics. Brinton, M. (1993). Women and the economic miracle: Gender and work in postwar Japan. Princeton, NJ: Princeton University Press. Central Intelligence Agency. (2002). World fact book 2002. Washington, DC: US Government Printing Office. Chen, C. N., Wong, J., Lee, N., Cha-Ho, M. W., Lau, J. T. K., & Fung, M. (1993). The Shatin Community Mental Health Survey in Hong Kong: Major findings. Archives of General Psychiatry, 50, 125–133. Cole, R. E., & Tominaga, K. (1976). Japan’s changing occupational structure and its significance. In H. Patrick (Ed.), Japanese industrialization and its social consequences (pp. 53–96). Berkeley, CA: University of California Press. Dohrenwend, B. P., Dohrenwend, B. S., Gould, M. S., Link, B., Neugebauer, R., & Wunsch-Hitzig, R. (1980). Mental illness in the United States: Epidemiological estimates. New York: Praeger. Dore, R. (1973). British factory, Japanese factory: The origins of diversity in industrial relations. Berkeley: University of California Press. Eaton, W. W., Muntaner, C., Smith, C., Tien, A., & Ybarra, M. (2004). Center for Epidemiological Studies Depression Scale: Review and revision (CESD and CESDR). In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (3rd ed.) (Vol. III). Mahwah, NJ: Lawrence Erlbaum. Elder, J. W. (1976). Comparative cross-national methodology. Annual Review of Sociology, 2, 209–230. Gove, W. R. (1972). The relationship between sex roles, mental illness, and marital status. Social Forces, 51, 34–44. Gove, W. R., & Tudor, J. (1973). Adult sex roles and mental illness. American Journal of Sociology, 78, 50–73.

ARTICLE IN PRESS A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292 Hamabata, M. M. (1990). Crested kimono: Power and love in the Japanese business family. Ithaca, NY: Cornell University Press. Horwitz, A. V. (2002). Outcomes in the sociology of mental health and illness: Where have we been and where are we going? Journal of Health and Social Behavior, 43, 143–151. Hwu, H. G., Chang, I. H., Yeh, E. K., Chang, C. J., & Yeh, L. L. (1966). Major depressive disorder in Taiwan defined by the Chinese diagnostic interview schedule. Journal of Nervous and Mental Disease, 184, 497–502. Inaba, A. (2002). Kekkon to distress (Marital status and psychological distress in Japan). Japanese Sociological Review, 52, 69–84 [in Japanese]. Inaba, A. (2004). NFRJ98 no chosa sekkei to deta tokusei (Sampling design and data characteristics of NFRJ98). In H. Watanabe, A. Inaba, & N. Shimazaki (Eds.), Gendai kazoku no kouzou to hen’you: Zenkoku kazoku chosa [NFRJ98] ni yoru keiryo bunseki (Structures and changes in contemporary Japanese families: Quantitative analyses of National Family Research [NFRJ98]) (pp. 15–24). Tokyo: University of Tokyo Press [in Japanese]. Ishida, H., Goldthorpe, J. H., & Erikson, R. (1991). Intergenerational class mobility in postwar Japan. American Journal of Sociology, 96, 954–992. Iwata, N., & Roberts, R. E. (1996). Age differences among Japanese on the Center for Epidemiological Studies Depression Scale: An ethnocultural perspective on somatization. Social Science & Medicine, 43, 967–974. Iwata, N., Roberts, C. R., & Kawakami, N. (1995). Japan-US comparison of responses to depression scale items among adult workers. Psychiatry Research, 58, 237–245. Kalleberg, A. L., & Lincoln, J. R. (1988). The structure of earning inequality in the United States and Japan. American Journal of Sociology, 94, S121–S153. Kawakami, N., Shimizu, H., Haratani, T., Iwata, N., & Kitamura, T. (2004). Lifetime and 6-month prevalence of DSM-III-R psychiatric disorders in an urban community in Japan. Psychiatry Research, 121, 293–301. Kessler, R. C. (1982). A disaggregation of the relationship between socioeconomic status and psychological distress. American Sociological Review, 47, 752–764. Kessler, R. C. (2002). Epidemiology of depression. In I. H. Gotlib, & C. L. Hammen (Eds.), Handbook of depression (pp. 23–42). New York: Guilford Press. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289, 3095–3105. Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19. Kessler, R. C., & Zhao, S. (1999). Overview of descriptive epidemiology of mental disorders. In C. S. Aneshensel, & J. C. Phelan (Eds.), Handbook of the sociology of mental health (pp. 127–150). New York: Kluwer Academic/Plenum. Kikkawa, T. (2000). Changes in the determinants of class identification in Japan. International Journal of Sociology, 30, 34–51.

2291

Kikuzawa, S. (2001). The structure of self-reported distress in the United States and Japan: NFR and NSFH [Japanese title not available]. Kazoku Shakaigaku Kenkyu (Japanese Journal of Family Sociology), 12, 247–259. Kleinman, A. (1986). The social origins of distress and disease. New Haven, CT: Yale University Press. Kohn, R., Dohrenwend, B. P., & Mirotznik, J. (1998). Epidemiological findings on selected psychiatric disorders in the general population. In B. P. Dohrenwend (Ed.), Adversity, stress, and psychopathology (pp. 235–284). New York: Oxford University Press. Kohn, M. L., Naoi, A., Schoenbach, C., Schooler, C., & Slomczynski, K. M. (1990). Position in the class structure and psychological functioning in the United States, Japan, and Poland. American Journal of Sociology, 95, 964–1008. Koike, K. (1983). Internal labor markets: Workers in large firms. In T. Shirai (Ed.), Contemporary industrial relations in Japan (pp. 29–62). Madison, WI: University of Wisconsin Press. Kousaka, K. (2000). The meaning of ‘middle’ identification in contemporary Japan: Debate on middle class and types of politics. Kwanseigakuin Daigaku Shakaigakubu Kiyou (Kwanseigakuin University Sociology Department Journal), 86, 145–159. Krause, N., Jay, G., & Liang, J. (1991). Financial strain and psychological well-being among the American and Japanese elderly. Psychology and Aging, 6, 170–181. Krause, N., & Liang, J. (1992). Cross-cultural variations in depressive symptoms in later life. International Psychogeriatrics, 4, 185–202. Lee, H. Y. (1991). The Kangwha Epidemiological Study of Mental Disorders: Methodological considerations. In S. Suzuki, & R. E. Roberts (Eds.), Methods and applications in mental health surveys: The Todai Health Index (pp. 211–227). Tokyo: University of Tokyo Press. Lee, C. K., Kwak, Y. S., Yamamoto, J., Rhee, H., Kim, Y. S., Han, J. H., et al. (1990). Psychiatric epidemiology in Korea. Part I: Gender and age differences in Seoul. Journal of Nervous and Mental Disease, 178, 242–246. Lee, C. K., Kwak, Y. S., Yamamoto, J., Rhee, H., Kim, Y. S., Han, J. H., et al. (1990). Psychiatric epidemiology in Korea. Part II: Urban and rural differences. Journal of Nervous and Mental Disease, 178, 247–252. Lepine, J. P. (2001). Epidemiology, burden, and disability in depression and anxiety. Journal of Clinical Psychiatry, 62(Suppl. 113), 4–10. Lin, N., & Lai, G. (1995). Urban stress in China. Social Science & Medicine, 41, 1131–1145. Lincoln, J. R., & Kalleberg, A. L. (1985). Work organization and workforce commitment: A study of plants and employees in the US and Japan. American Sociological Review, 50, 738–760. Link, B., & Dohrenwend, B. (1980). Formulation of hypotheses about the true prevalence of demoralization in the United States. In B. P. Dohrenwend, B. S. Dohrenwend, M. S. Gould, B. Link, R. Neugebauer, & R. Wunsch-Hitzig (Eds.), Mental illness in the United States: Epidemiological estimates (pp. 114–132). New York: Praeger. Markus, H., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98, 224–253.

ARTICLE IN PRESS 2292

A. Inaba et al. / Social Science & Medicine 61 (2005) 2280–2292

Mirowsky, J., & Ross, C. (2003). Social causes of psychological distress (2nd ed.). New York: Aldine de Gruyter. Nakane, C. (1973). Japanese society (revised edition). New York: Pelican Books. National Center for Education Statistics. (1999). The condition of education. Washington, DC: US Department of Education. Nolen-Hoeksema, S. (1990). Sex differences in depression. Stanford, CA: Stanford University Press. Oishi, S. (2002). The experiencing and remembering of wellbeing: A cross-cultural analysis. Personality and Social Psychology Bulletin, 28, 1398–1406. Price, R. K., Shea, B. M., Murry, K. S., & Hilditch, D. J. (1995). Introduction. In R. K. Price, B. M. Shea, & H. N. Mookherjee (Eds.), Social psychiatry across cultures: Studies from North America, Asia, Europe, and Africa (pp. 1–16). New York: Plenum. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. Robins, L. N., Helzer, J. E., Weissman, M. M., Orvaschel, H., Gruenberg, E., Burke, J. D., Jr., et al. (1984). Lifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry, 41, 949–958. Rosenfield, S. (1989). The effects of women’s employment: Personal control and sex differences in mental health. Journal of Health and Social Behavior, 30, 77–91. Simon, G. E., Goldberg, D. P., Von Korff, M., & Ustun, T. B. (2002). Understanding cross-national differences in depression prevalence. Psychological Medicine, 32, 585–594. Sweet, J. A., & Bumpass, L. L. (1996). The National Survey of Families and Households-waves 1 and 2: Data description and documentation. Madison, WI: Center for Demography and Ecology, University of Wisconsin. Tseng, W. S., Ebata, K., Kim, K. I., Krahl, W., Kua, E. H., Lu, Q., et al. (2001). Mental health in Asia: Social improvements

and challenges. International Journal of Social Psychiatry, 47, 8–23. Turner, R. J., & Lloyd, D. A. (1999). The stress process and the social distribution of depression. Journal of Health and Social Behavior, 40, 374–404. Turner, R. J., Lloyd, D. A., & Roszell, P. (1999). Personal resources and the social distribution of depression. American Journal of Community Psychology, 27, 643–672. Turner, R. J., & Roszell, P. (1994). Psychosocial resources and the stress process. In W. R. Avison, & I. H. Gotlib (Eds.), Stress and mental health: Contemporary issues and prospects for the future (pp. 179–210). New York: Plenum. Watanabe, H., Inaba, A., & Shimazaki, N. (Eds.). (2004). Gendai kazoku no kouzou to hen’you: Zenkoku kazoku chosa [NFRJ98] ni yoru keiryo bunseki (Structures and changes in contemporary Japanese families: Quantitative analyses of National Family Research [NFRJ98]). Tokyo: University of Tokyo Press [In Japanese]. Weissman, M. M., Bland, R. C., Canino, G. J., Faravelli, C., Greenwald, S., Hwu, H.-G., et al. (1996). Crossnational epidemiology of major depression and bipolar disorder. Journal of the American Medical Association, 276, 293–299. Weissman, M. M., Bruce, M. L., Leaf, P. J., Florio, L. P., & Holzer, C., III (1991). Affective disorders. In L. N. Robins, & D. A. Regier (Eds.), Psychiatric disorders in America: The Epidemiologic Catchment Area Study (pp. 53–80). New York: Free Press. WHO International Consortium in Psychiatric Epidemiology. (2000). Cross-national comparisons of the prevalences and correlates of mental disorders. Bulletin of the World Health Organization, 78, 413–426. Wright, E. O., Baxter, J., & Birkelund, G. E. (1995). The gender gap in workplace authority: A cross-national study. American Sociological Review, 60, 407–435.